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PubMed1993

Quality evaluation of controlled clinical information service trials.

Randomized controlled clinical trials are increasingly accepted as tools of computer technology assessment and, therefore, quality evaluation of trials has great theoretical and practical significance. The purpose of this study was to assist the design of evaluation studies and synthesis of published results by developing and validating an easy-to-use quality scoring method. The development of the new scoring system was based on the available quality evaluation methods and the analysis of 19 trial reports registered in the Columbia Registry of Controlled Clinical Information Service Trials. First critical aspects and afterwards the levels of quality were defined. In spite of the fact that all quality requirements were met by some trials, the average overall quality score was 52.6 (+/- 8.7) per cent. The minimum score was 37 and the maximum was 72 per cent. Data collection and site/sample definition were better in the good quality trials, but improvement in statistical analysis was erratic. The quality scoring method was validated by using another sample of 20 registered trials. While the number of published controlled clinical trials is increasing in medical informatics, the analysis was unable to demonstrate a significant positive correlation between the quality and year of publication.

Evaluation Studies as Topic↗
PubMed1995

Situated clinical cognition.

The features characterizing study of clinical cognition in situ are formulated as: Re-cognition of context, culture, history and affect. Socializing and phenomenalistic elements are again included in the research agenda. Interest for representations: an analysis level is reserved for the symbols, rules and images relevant to define in models of clinical cognition. De-emphasis on computer modeling: investigations focus on the 'functional systems' in which computers are involved. Rootedness in classical philosophical problems: issues concerning situated clinical cognition are connected to the width of available theoretical literature. Belief in interdisciplinary studies: productive interactions between the new and traditional disciplines is anticipated, implying that new shared methods have to be developed. When scientific perspectives are broadened, a new balance has to be found between the relevance of the subject of study and methodological rigor. The situated clinical cognition framework is to allow for moving between models, theories, and perspectives, as it does not presuppose a singular model of clinical thinking.

Artificial Intelligence↗
PubMed1995

Inter- and intracellular computation models based on Boolean vs. non-Boolean inconsistency.

Systems involving both intracellular and intercellular computation are destined to be described as non-computable. We propose a model for such systems by introducing the inconsistent relation of Boolean and non-Boolean logic. Cellular automata fashioned model exhibits an evolution like class 4 located at the edge of chaos, while there is no local rule for universality existing over the whole space in our model. A system featuring the inconsistent vertical scheme is approximately articulated into a hierarchical system, whose wholeness cannot be deduced by any approximated local rule. In other words, undecidability between a part and whole comprises a hierarchical structure.

Animals↗
PubMed1993

A multifunction and programmable computerized barostat.

A new computerized barostat allowing digestive tone measurement but also programmed distensions is described. The apparatus consists of a pump, driven by a computer, which injects or aspirates air in a flacid bag placed in a part of the gastrointestinal tract when relaxation or contraction occurs. Several parameters can be programmed for tone measurement: mean pressure, window pressure and air flow rate. Isovolumic or isobaric distensions can be performed using three modes: linear, stepwise or step by step with intermediate deflation. The height (mL or mmHg) of the steps and the duration of the distensions and the deflations can also be programmed. Three automatic and one manual safety systems are included. In comparison with previously described barostats the main feature of this apparatus is that it is entirely computerized and can be used for programmed distensions.

Atropine↗
PubMed1994

The development of a client application for the collaborative social and medical services system.

This paper describes the design and implementation of a client application for the Baylor College of Medicine Teen Health Clinics. The application is the front end to the Collaborative Social and Medical Services System (CSMSS) under development by Baylor's Medical Informatics and Computing Research Program [8]. The application provides distributed access to an underlying object oriented database system. A process driven and patient centered design will provide staff members with a complete set of services, including forms for data entry and viewing, query, and access management to facilitate efficient and effective delivery of services. Role-specific interfaces will be supplied for clerks, nurses, nurse practitioners, physicians, and social workers. The client application is being designed using object oriented methodologies and technologies with the C++ programming language, and will operate within a Microsoft Windows operating environment utilizing Object Linking and Embedding for application interoperability.

Adolescent↗
PubMed1989

Efficient storage of urodynamic signals by computer: application of FAN adaptive sampling.

Digital storage of urodynamic signals such as detrusor pressure and flowrate at a sufficiently high sampling rate (10 samples per second) to allow subsequent analysis requires considerable computer memory. A procedure for compressing these data by deleting redundant samples (the fan method of adaptive sampling) was tested. The method allows a flexible adaptation to specific hardware and a compromise between storage requirements and accuracy. In this study the number of samples required for adequate reconstruction of the detrusor pressure signal could be varied from 80% to 4% of the original number of samples by varying the average difference between reconstructed and original signal from 0.01 to 2 cm H2O. Fast components of the measurements (for example cough peaks) which were lost if a lower sampling rate or averaging was used to obtain equally low storage requirements were unaffected by this compression technique.

Algorithms↗
PubMedDate not supplied

Using ICPC in a computer-based primary care information system.

INTRODUCTION: Although the framework of the episode of care offers much promise in examining the process of primary health care, the development of episode-oriented, automated data sources has proceeded slowly. Experience with the International Classification of Primary Care (ICPC) in the European Community has confirmed its usefulness in creating and analyzing episodes of care, but it has seen little use in the United States. We describe the development of a Primary Care Information System (PCIS), which employs ICPC to create episodes of care from routinely collected clinical data. METHODS: The PCIS is a partially computerized medical information system running on a standard Macintosh microcomputer. The PCIS integrates ICPC, ICD-9-CM, and CPT-4 coding structures to provide episode-oriented data for clinical, administrative, research, and reimbursement needs. The performance of the PCIS was assessed based on five major issues: clinician cooperation, data-entry accuracy, validity of episode data, cost, and perceived value to users. RESULTS: The data collection and entry process required minimal additional effort from clinicians and data-entry personnel, and data-entry accuracy exceeded published estimates for other primary care data sources. Data management costs of about $1 per encounter compare favorably to published estimates for other office-based clinical information systems. The major problem seen during pilot testing was inaccurate tracking of episode boundaries through changes in providers and consequent changes in labels for problems and diagnoses. This problem has been addressed in development of the second-generation PCIS. CONCLUSION: The combination of an episode-oriented framework such as ICPC and a flexible medical information system provides a promising platform for the study of the content and process of primary health care.

Family Practice↗
PubMed1991

Automated analysis of medical text. II. Cognitive strategy.

In a previous paper, the authors described three paradigms applicable to automated medical text analysis. In this paper, the relative importance of the three paradigms is discussed, viz. the relative value of the linguistic word categorization, the semantic paradigm, and the medical fact delineation. The strategy adopted was to limit the linguistic disambiguation and apply probabilistic rules, in order to speed up the analytic process.

Algorithms↗
PubMed1994

The role of standards in creating a health information infrastructure.

In the belief that the existence of a variety of standards is an absolute necessity for health care professional workstations to work, this paper provides a detailed overview of the standards efforts of a number of groups. According to the International Standards Organization (ISO) Reference Model, workstations require a full level of standards from the physical level through and beyond the applications level. Rapidly changing technology challenges acceptance of standards at the lower levels. Current recommendations include fiberoptic media using certain protocols. Other standards in these lower levels also have support. At the applications level, data messaging standards are being developed by six groups. The consensus standards body for the United States is coordinating the efforts of these groups in order to produce a harmonized effort, and is coordinating the effort with Europe for an international effort. Work on the development of the full set of standards necessary for workstation implementations is lagging. Accelerating the process is mandatory if we are to achieve the necessary seamless interoperability required by workstations for ubiquitous intelligent communications between the workstations and the sources of data.

Database Management Systems↗
PubMed1994

Functional requirements as an integral part of the design and development process: summary and recommendations.

The Health Care Professional Workstation (HCPW) provides a portal to the health care system as a whole. Through this portal the health care professional must be able to carry out a wide variety of tasks in an integrated fashion. Traditional health care information systems have not been designed to support this kind of use, so the functional requirements development process must be capable of leading to an architecture and components for a system that will support such use. A variety of approaches may be employed to develop functional requirements, which may be used singly or in combination. Recommendations for this activity center on domain delineation, evaluation efforts to establish the most effective approaches, detailed functional requirement development, evaluation of the developed functional requirements, creation of shared resources, and education and training in the use of the tools and methodologies.

Database Management Systems↗
PubMed1989

Querying medical databases in an environment offering logical data independence.

Medical information systems are becoming popular. Furthermore, their use is expected to be expanded in future. In order to easily extract information from the underlying databases, easy to use man-machine interfaces are required. This paper concerns the doctor interface of the ARPIA medical information system based on a relational database management system. The whole system is currently used inside the Outpatient Pediatric Clinic of the Catholic University of Rome, Italy. The interface provides logical data independence towards the underlying relational database. The paper contains some background about this kind of interfaces, and also, it sketches the software architecture of the implemented prototype.

Database Management Systems↗
PubMed1995

Introduction to the Bioelectronic Devices Project in Japan.

The Bioelectronic Devices Project was organized in Japan as a 10-year national project and it has been working toward developing fundamental key technologies for designing and assembling innovative information-processing devices by realizing the excellent functions specifically found in molecular assemblies and information processing of living organisms. The project is now in the third year of the second phase (the 8th year of its 10-year duration) and researchers have been trying to elucidate the specific characters of the prototype devices. The outline of this challenging project is given with the latest experimental results.

Electron Transport↗
PubMed1996

Developing a database of published reports of randomised clinical trials in pain research.

A database of randomised clinical trials (RCTs) in pain research published from 1950 to 1990 was created following an extensive literature search. By applying a refined MEDLINE search strategy from 1966 to 1990 and by hand-searching more than 1,000,000 pages of a total of 40 biomedical journals published during the period 1950-1990, more than 8000 RCTs were identified. The RCTs were published in more than 800 journals and over 85% appeared between 1976 and 1990. If the trend of the last 15 years persists, a total of more than 15 000 RCTs will be published in pain relief by the year 2000. A detailed description of methods to ensure efficient use of resources during the identification, retrieval and management of the information in pain relief and other fields is given. Emphasis is made on the importance of refining MEDLINE search strategies, on the use of volunteers to hand-search journals and on careful monitoring of each of the steps of the process. The potential uses of the database to guide clinical and research decisions are discussed.

Databases, Bibliographic↗
PubMed1995

A case study in ontology library construction.

The goal of our work is to facilitate the development of medical knowledge-based systems by providing a library of reusable ontologies. The availability of such a library reduces the amount of knowledge acquisition required to create knowledge bases of new applications, and makes it easier to connect a knowledge-based system to existing data bases. This article presents a case study in constructing such a library. The emphasis is on studying the principles that underly the internal structure of the library as well as on the process of constructing and using the library. We envision that, in the future, application ontologies can be constructed by the selection and refinement of generic ontologies and domain ontologies from such a library.

Artificial Intelligence↗
PubMedDate not supplied

An Internet primer for emergency physicians: Part I.

The growth of the popularity of the Internet is nothing short of phenomenal. Increasingly, valuable medical information is becoming available on line for physicians and health consumers alike. Physicians can clearly benefit personally and professionally by obtaining access to the Internet. The purpose of this article is to introduce the Internet to physicians who have limited experience with this new medium. It discusses the concept of the Internet, the necessary computer components and modem for on line connection, and the various types of Internet Service Providers. A glossary is also provided to explain some of the most common terminology used in the Internet culture.

Computer Communication Networks↗